Kobayashi Mariko, Suzuki Fumitaka, Akuta Norio, Hosaka Tetsuya, Sezaki Hitomi, Yatsuji Hiromi, Yatsuji Hiromi, Kobayashi Masahiro, Suzuki Yoshiyuki, Arase Yasuji, Ikeda Kenji, Watahiki Sachiyo, Iwasaki Satomi, Miyakawa Yuzo, Kumada Hiromitsu
Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan.
J Med Virol. 2007 Oct;79(10):1472-7. doi: 10.1002/jmv.20994.
Although loss of hepatitis B e antigen (HBeAg) from the serum is sought by treatment with lamivudine, clearance of hepatitis B surface antigen (HBsAg) is the eventual goal of any antiviral therapy. In a single hepatology center in the Metropolitan Tokyo, 486 patients with chronic hepatitis B were followed up for longer than 3 years after they started treatment with lamivudine. HBsAg disappeared from the serum in 17 (3.5%). Age >or=50 years and low HBsAg levels (hemagglutination titer <or=2(7)) at the start of lamivudine were significantly more frequent in the patients who did than did not lose HBsAg from the serum. Except for these two factors, there were no differences between the two groups of patients in the prevalence of HBeAg and HBV DNA levels at the baseline, as well as the development of YMDD mutants and breakthrough hepatitis during lamivudine treatment. Using multivariate analysis, age >or=50 years at the start of lamivudine was the only factor predicting the loss of HBsAg (hazard ratio: 2.96 [95% confidence interval: 1.14-7.68], P = 0.028). By the method of Kaplan-Meier performed on the 486 patients, the loss of HBsAg was estimated to occur in 3% and 13% of patients, respectively, who had received lamivudine therapy for 5 and 10 years. These results indicate that loss of HBsAg occurs in a minority (3.5%) of patients with chronic hepatitis B who receive lamivudine therapy and more frequently in those with lower HBsAg titers and older ages at the start of treatment.
虽然拉米夫定治疗旨在使血清中的乙肝e抗原（HBeAg）消失，但清除乙肝表面抗原（HBsAg）是任何抗病毒治疗的最终目标。在东京都的一个单一肝病中心，486例慢性乙型肝炎患者在开始拉米夫定治疗后接受了超过3年的随访。血清中HBsAg消失的患者有17例（3.5%）。在血清中HBsAg消失的患者中，拉米夫定治疗开始时年龄≥50岁且HBsAg水平较低（血凝滴度≤2⁷）的情况明显更为常见。除这两个因素外，两组患者在基线时HBeAg的流行率、HBV DNA水平以及拉米夫定治疗期间YMDD突变体的发生和突破性肝炎方面均无差异。通过多变量分析，拉米夫定治疗开始时年龄≥50岁是预测HBsAg消失的唯一因素（风险比：2.96 [95%置信区间：1.14 - 7.68]，P = 0.028）。通过对486例患者进行Kaplan - Meier方法分析，估计接受拉米夫定治疗5年和10年的患者中，HBsAg消失率分别为3%和13%。这些结果表明，接受拉米夫定治疗的慢性乙型肝炎患者中，少数（3.5%）会出现HBsAg消失，且在治疗开始时HBsAg滴度较低和年龄较大的患者中更常见。
